COH-MentalHealthBook

MENTAL HEALTH & ADDICTION INTERVENTIONS FOR YOUTH EXPERIENCING HOMELESSNESS:
PRACTICAL STRATEGIES FOR FRONT-LINE PROVIDERS
Functional analysis
Therapists should complete a functional analysis during the beginning phases of treatment.
Sample forms for a functional analysis can be found in Meyers and Smith’s (1995) CRA
manual. The purpose of the functional analysis is to reveal the situations in which youth are
most likely to use substances. First, the therapist identifies internal triggers (e.g., feelings,
mood) and external triggers (e.g., fights with friends, getting money) for substance use.
For example, a client might find that she always feels the urge to smoke after arguing
with her romantic partner. Next, positive consequences of the client’s substance use are
identified. The therapist then helps the client find alternative behaviours that achieve the
same positive outcomes. For example, if the client says smoking helps her calm down after
a fight with her partner, the therapist helps her determine prosocial behaviours that are
relaxing, such as listening to music or exercising. The therapist and the client also discuss
the negative consequences of the client’s substance use. Identifying negative consequences
can motivate clients to decrease their substance use. In later sessions, the therapist can
gently remind the client of those negative consequences. It is also recommended that the
therapist complete a functional analysis of targeted prosocial behaviours with the client to
highlight positive behaviours the client enjoys that can replace substance use. Additional
functional analyses can be completed if the client wants to discuss other behaviours. The
information gathered from the functional analysis informs the direction of treatment and
helps the therapist determine which treatment modules to use.
Skills training and role-playing
CRA includes modules for skills training in several areas, including employment,
communication, drug and alcohol refusal, relapse prevention, and problem solving. The
specific skills targeted in the intervention depend on the counselling goals the client
identifies. Regardless of the targeted skills, in-session role-playing is a critical component
in building new skills. During role plays, the therapist identifies a situation the client may
experience and coaches the client on how to handle it. Role-playing in session gives clients
an opportunity to practise the skills they are learning and allows the therapist to observe
and provide feedback on the targeted skill. Observation during the role play can help the
therapist understand aspects of the skill that may be more challenging for the client. The
therapist should reinforce positive behaviours observed during the role play. For example,
if the target area is employment, the client can role play a job interview with the therapist.
The therapist may observe that the client provides inappropriate responses to interview
questions, but appears confident and makes good eye contact. The therapist can help the
client develop more appropriate responses to the questions, but also commend the client
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